Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim and Entitlement Appeals; Quarterly Listing of Program Issuances-July Through September 2023, 89710-89711 [2023-28625]
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89710
Federal Register / Vol. 88, No. 248 / Thursday, December 28, 2023 / Notices
TOTAL ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Form name
(includes the ANE program specific tables and attachments)
Number of
responses per
respondent
Total
responses
Average
burden per
response
(in hours)
Total burden
hours
Advanced Nursing Education Sexual Assault Nurse Examiners ..................................................................................
ANE–NPRF ..........................................................................
Maternity Care Nursing Workforce Expansion ....................
54
64
10
1
1
1
54
64
10
7
7
7
378
448
70
Total ..............................................................................
348
........................
348
........................
2,436
HRSA specifically requests comments
on (1) the necessity and utility of the
proposed information collection for the
proper performance of the agency’s
functions, (2) the accuracy of the
estimated burden, (3) ways to enhance
the quality, utility, and clarity of the
information to be collected, and (4) the
use of automated collection techniques
or other forms of information
technology to minimize the information
collection burden.
Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2023–28664 Filed 12–27–23; 8:45 am]
BILLING CODE 4165–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
[OMHA–2302–N]
Medicare Program; Administrative Law
Judge Hearing Program for Medicare
Claim and Entitlement Appeals;
Quarterly Listing of Program
Issuances—July Through September
2023
Office of Medicare Hearings
and Appeals (OMHA), HHS.
ACTION: Notice.
AGENCY:
This quarterly notice lists the
OMHA Case Processing Manual (OCPM)
instructions that were published from
July through September 2023. This
manual standardizes the day-to-day
procedures for carrying out adjudicative
functions, in accordance with
applicable statutes, regulations, and
OMHA directives, and gives OMHA
staff direction for processing appeals at
the OMHA level of adjudication.
FOR FURTHER INFORMATION CONTACT: Jon
Dorman, by telephone at (571) 457–
7220, or by email at jon.dorman@
hhs.gov.
SUPPLEMENTARY INFORMATION:
SUMMARY:
khammond on DSKJM1Z7X2PROD with NOTICES
Number of
respondents
I. Background
The Office of Medicare Hearings and
Appeals (OMHA), a staff division within
the Office of the Secretary within the
VerDate Sep<11>2014
20:14 Dec 27, 2023
Jkt 262001
U.S. Department of Health and Human
Services (HHS), administers the
nationwide Administrative Law Judge
hearing program for Medicare claim;
organization, coverage, and at-risk
determination; and entitlement appeals
under sections 1869, 1155,
1876(c)(5)(B), 1852(g)(5), and 1860D–
4(h) of the Social Security Act (the Act).
OMHA ensures that Medicare
beneficiaries and the providers and
suppliers that furnish items or services
to Medicare beneficiaries, as well as
Medicare Advantage organizations
(MAOs), Medicaid State agencies, and
applicable plans, have a fair and
impartial forum to address
disagreements with Medicare coverage
and payment determinations made by
Medicare contractors, MAOs, or Part D
plan sponsors (PDPSs), and
determinations related to Medicare
eligibility and entitlement, Part B late
enrollment penalty, and income-related
monthly adjustment amounts (IRMAA)
made by the Social Security
Administration (SSA).
The Medicare claim, organization
determination, coverage determination,
and at-risk determination appeals
processes consist of four levels of
administrative review, and a fifth level
of review with the Federal district
courts after administrative remedies
under HHS regulations have been
exhausted. The first two levels of review
are administered by the Centers for
Medicare & Medicaid Services (CMS)
and conducted by Medicare contractors
for claim appeals, by MAOs and an
Independent Review Entity (IRE) for
Part C organization determination
appeals, or by PDPSs and an IRE for Part
D coverage determination and at-risk
determination appeals. The third level
of review is administered by OMHA and
conducted by Administrative Law
Judges and attorney adjudicators. The
fourth level of review is administered by
the HHS Departmental Appeals Board
(DAB) and conducted by the Medicare
Appeals Council (Council). In addition,
OMHA and the DAB administer the
second and third levels of appeal,
PO 00000
Frm 00057
Fmt 4703
Sfmt 4703
respectively, for Medicare eligibility,
entitlement, Part B late enrollment
penalty, and IRMAA reconsiderations
made by SSA; a fourth level of review
with the Federal district courts is
available after administrative remedies
within SSA and HHS have been
exhausted.
Sections 1869, 1155, 1876(c)(5)(B),
1852(g)(5), and 1860D–4(h) of the Act
are implemented through the
regulations at 42 CFR part 405 subparts
I and J; part 417, subpart Q; part 422,
subpart M; part 423, subparts M and U;
and part 478, subpart B. As noted above,
OMHA administers the nationwide
Administrative Law Judge hearing
program in accordance with these
statutes and applicable regulations. To
help ensure nationwide consistency in
that effort, OMHA established a manual,
the OCPM. Through the OCPM, the
OMHA Chief Administrative Law Judge
establishes the day-to-day procedures
for carrying out adjudicative functions,
in accordance with applicable statutes,
regulations, and OMHA directives. The
OCPM provides direction for processing
appeals at the OMHA level of
adjudication for Medicare Part A and B
claims; Part C organization
determinations; Part D coverage
determinations and at-risk
determinations; and SSA eligibility and
entitlement, Part B late enrollment
penalty, and IRMAA determinations.
Section 1871(c) of the Act requires
that the Secretary publish a list of all
Medicare manual instructions,
interpretive rules, statements of policy,
and guidelines of general applicability
not issued as regulations at least every
three months in the Federal Register.
II. Format for the Quarterly Issuance
Notices
This quarterly notice provides the
specific updates to the OCPM that have
occurred in the three-month period of
July through September 2023. A
hyperlink to the available chapters on
the OMHA website is provided below.
The OMHA website contains the most
current, up-to-date chapters and
revisions to chapters, and will be
E:\FR\FM\28DEN1.SGM
28DEN1
Federal Register / Vol. 88, No. 248 / Thursday, December 28, 2023 / Notices
available earlier than we publish our
quarterly notice. We believe the OMHA
website provides more timely access to
the current OCPM chapters for those
involved in the Medicare claim;
organization, coverage, and at-risk
determination; and entitlement appeals
processes. We also believe the website
offers the public a more convenient tool
for real time access to current OCPM
provisions. In addition, OMHA has a
listserv to which the public can
subscribe to receive notification of
certain updates to the OMHA website,
including when new or revised OCPM
chapters are posted. If accessing the
OMHA website proves to be difficult,
the contact person listed above can
provide the information.
III. How To Use the Notice
This notice lists the OCPM chapters
and subjects published during the
quarter covered by the notice so the
reader may determine whether any are
of particular interest. The OCPM can be
accessed at https://www.hhs.gov/about/
agencies/omha/the-appeals-process/
case-processing-manual/.
khammond on DSKJM1Z7X2PROD with NOTICES
IV. OCPM Releases for July Through
September 2023
The OCPM is used by OMHA
adjudicators and staff to administer the
OMHA program. It offers day-to-day
operating instructions, policies, and
procedures based on statutes and
regulations, and OMHA directives.
The following is a list and description
of OCPM provisions that were issued or
revised in the three-month period of
July through September 2023. This
information is available on our website
at https://www.hhs.gov/about/agencies/
omha/the-appeals-process/caseprocessing-manual/.
OCPM Chapter 20 (Post-Adjudication
Actions) Updates
OMHA issued the initial version of
this chapter on May 25, 2018, and
included it in a quarterly notice
published in the August 7, 2018 Federal
Register (83 FR 38700). The revised
chapter addresses changes to postadjudication appeals processing
resulting from increased electronic case
processing through OMHA’s Electronic
Case Adjudication and Processing
Environment (ECAPE), advances in
appeal filing procedures through the eAppeal Portal, and other improvements
in appeals operations and processing.
This revision removes outdated data
entry processes that were updated with
electronic case processing. This revision
also clarifies how post-adjudication
actions are processed if the original
adjudicator is not available for more
VerDate Sep<11>2014
20:14 Dec 27, 2023
Jkt 262001
than 20 calendar days; clarifies how
various post-adjudication requests are
filed; updates the operational process to
re-establish an appeal. Finally, the
revision adds a new section, 20.13,
Requests to Obtain Approval of a Fee,
which incorporates information
previously included in OCPM Chapter
5. OMHA made revisions in the
following sections: 20.2.1, 20.2.2, 20.3.2,
20.3.4, 20.4.1, 20.4.3, 20.4.4, 20.4.5,
20.4.6, 20.5.2, 20.5.3, 20.5.4, 20.5.5
(multiple), 20.5.7 (multiple), 20.5.8
(multiple), 20.6.1 (multiple), 20.6.2,
20.6.4, 20.6.5 (multiple), 20.6.6.1, 20.6.7
(multiple), 20.7.1.4, 20.7.2, 20.7.4,
20.7.5 (multiple), 20.7.7 (multiple),
20.8.1.3, 20.8.2, 20.8.4, 20.8.5
(multiple), 20.8.6.1, 20.8.7 (multiple),
20.9.1, 20.9.2, 20.9.4, 20.9.5, 20.10.2,
20.10.3, 20.11.2, 20.11.4, 20.11.5,
20.11.6, 20.12.1, 20.12 (multiple), 20.13.
Karen W. Ames,
Executive Director of Operations, Office of
Medicare Hearings and Appeals.
[FR Doc. 2023–28625 Filed 12–27–23; 8:45 am]
89711
Background
The TMG Program is a competitive
grant program that is capacity building
and developmental in nature and has
been available for federally recognized
Indian Tribes and Tribal Organizations
(T/TO) since shortly after enactment of
the ISDEAA in 1975. The TMG Program
was established to assist T/TOs to
prepare for assuming all or part of
existing IHS programs, functions,
services, and activities (PFSAs) and
further develop and improve Tribal
health management capabilities. The
TMG Program provides competitive
grants to T/TOs to establish goals and
performance measures for current health
programs, assess current management
capacity to determine if new
components are appropriate, analyze
programs to determine if a T/TO’s
management is practicable, and develop
infrastructure systems to manage or
organize PFSAs.
Purpose
I. Funding Opportunity Description
The purpose of this program is to
enhance and develop health
management infrastructure and assist T/
TOs in assuming all or part of existing
IHS PFSAs through a title I ISDEAA
contract and assist established title I
ISDEAA contractors and title V ISDEAA
compactors to further develop and
improve management capability. In
addition, Tribal Management Grants are
available to T/TOs under the authority
of 25 U.S.C. 5322(e) for the following:
1. Obtaining technical assistance from
providers designated by the T/TO
(including T/TOs that operate mature
contracts) for the purposes of program
planning and evaluation, including the
development of any management
systems necessary for contract
management, and the development of
cost allocation plans for indirect cost
rates.
2. Planning, designing, monitoring,
and evaluating Federal programs serving
T/TOs, including Federal administrative
functions.
Statutory Authority
II. Award Information
The Indian Health Service (IHS) is
accepting applications for grants for the
Tribal Management Grant (TMG)
Program. This program is authorized
under the Snyder Act, 25 U.S.C. 13; the
Transfer Act, 42 U.S.C. 2001(a); and the
Indian Self-Determination and
Education Assistance Act (ISDEAA),
Public Law 93–638, as amended, 25
U.S.C. 5322(b)(2) and 25 U.S.C. 5322(e).
The Assistance Listings section of
SAM.gov (https://sam.gov/content/
home) describes this program under
93.228.
Funding Instrument—Grant
BILLING CODE 4150–46–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Indian Health Service
Funding Opportunity for the Tribal
Management Grant Program
Announcement Type: New.
Funding Announcement Number:
HHS–2024–IHS–TMD–0001.
Assistance Listing (Catalog of Federal
Domestic Assistance or CFDA) Number:
93.228.
Key Dates
Application Deadline Date: March 14,
2024.
Earliest Anticipated Start Date: June
1, 2024.
PO 00000
Frm 00058
Fmt 4703
Sfmt 4703
Estimated Funds Available
The total funding identified for fiscal
year (FY) 2024 is approximately
$2,464,000. Individual award amounts
for the first budget year are anticipated
to be between $50,000 and $150,000.
The funding available for competing
and subsequent continuation awards
issued under this announcement is
subject to the availability of
appropriations and budgetary priorities
of the Agency. The IHS is under no
E:\FR\FM\28DEN1.SGM
28DEN1
]]>Agencies
[Federal Register Volume 88, Number 248 (Thursday, December 28, 2023)]
[Notices]
[Pages 89710-89711]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28625]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OMHA-2302-N]
Medicare Program; Administrative Law Judge Hearing Program for
Medicare Claim and Entitlement Appeals; Quarterly Listing of Program
Issuances--July Through September 2023
AGENCY: Office of Medicare Hearings and Appeals (OMHA), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This quarterly notice lists the OMHA Case Processing Manual
(OCPM) instructions that were published from July through September
2023. This manual standardizes the day-to-day procedures for carrying
out adjudicative functions, in accordance with applicable statutes,
regulations, and OMHA directives, and gives OMHA staff direction for
processing appeals at the OMHA level of adjudication.
FOR FURTHER INFORMATION CONTACT: Jon Dorman, by telephone at (571) 457-
7220, or by email at [email protected].
SUPPLEMENTARY INFORMATION:
I. Background
The Office of Medicare Hearings and Appeals (OMHA), a staff
division within the Office of the Secretary within the U.S. Department
of Health and Human Services (HHS), administers the nationwide
Administrative Law Judge hearing program for Medicare claim;
organization, coverage, and at-risk determination; and entitlement
appeals under sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and
1860D-4(h) of the Social Security Act (the Act). OMHA ensures that
Medicare beneficiaries and the providers and suppliers that furnish
items or services to Medicare beneficiaries, as well as Medicare
Advantage organizations (MAOs), Medicaid State agencies, and applicable
plans, have a fair and impartial forum to address disagreements with
Medicare coverage and payment determinations made by Medicare
contractors, MAOs, or Part D plan sponsors (PDPSs), and determinations
related to Medicare eligibility and entitlement, Part B late enrollment
penalty, and income-related monthly adjustment amounts (IRMAA) made by
the Social Security Administration (SSA).
The Medicare claim, organization determination, coverage
determination, and at-risk determination appeals processes consist of
four levels of administrative review, and a fifth level of review with
the Federal district courts after administrative remedies under HHS
regulations have been exhausted. The first two levels of review are
administered by the Centers for Medicare & Medicaid Services (CMS) and
conducted by Medicare contractors for claim appeals, by MAOs and an
Independent Review Entity (IRE) for Part C organization determination
appeals, or by PDPSs and an IRE for Part D coverage determination and
at-risk determination appeals. The third level of review is
administered by OMHA and conducted by Administrative Law Judges and
attorney adjudicators. The fourth level of review is administered by
the HHS Departmental Appeals Board (DAB) and conducted by the Medicare
Appeals Council (Council). In addition, OMHA and the DAB administer the
second and third levels of appeal, respectively, for Medicare
eligibility, entitlement, Part B late enrollment penalty, and IRMAA
reconsiderations made by SSA; a fourth level of review with the Federal
district courts is available after administrative remedies within SSA
and HHS have been exhausted.
Sections 1869, 1155, 1876(c)(5)(B), 1852(g)(5), and 1860D-4(h) of
the Act are implemented through the regulations at 42 CFR part 405
subparts I and J; part 417, subpart Q; part 422, subpart M; part 423,
subparts M and U; and part 478, subpart B. As noted above, OMHA
administers the nationwide Administrative Law Judge hearing program in
accordance with these statutes and applicable regulations. To help
ensure nationwide consistency in that effort, OMHA established a
manual, the OCPM. Through the OCPM, the OMHA Chief Administrative Law
Judge establishes the day-to-day procedures for carrying out
adjudicative functions, in accordance with applicable statutes,
regulations, and OMHA directives. The OCPM provides direction for
processing appeals at the OMHA level of adjudication for Medicare Part
A and B claims; Part C organization determinations; Part D coverage
determinations and at-risk determinations; and SSA eligibility and
entitlement, Part B late enrollment penalty, and IRMAA determinations.
Section 1871(c) of the Act requires that the Secretary publish a
list of all Medicare manual instructions, interpretive rules,
statements of policy, and guidelines of general applicability not
issued as regulations at least every three months in the Federal
Register.
II. Format for the Quarterly Issuance Notices
This quarterly notice provides the specific updates to the OCPM
that have occurred in the three-month period of July through September
2023. A hyperlink to the available chapters on the OMHA website is
provided below. The OMHA website contains the most current, up-to-date
chapters and revisions to chapters, and will be
[[Page 89711]]
available earlier than we publish our quarterly notice. We believe the
OMHA website provides more timely access to the current OCPM chapters
for those involved in the Medicare claim; organization, coverage, and
at-risk determination; and entitlement appeals processes. We also
believe the website offers the public a more convenient tool for real
time access to current OCPM provisions. In addition, OMHA has a
listserv to which the public can subscribe to receive notification of
certain updates to the OMHA website, including when new or revised OCPM
chapters are posted. If accessing the OMHA website proves to be
difficult, the contact person listed above can provide the information.
III. How To Use the Notice
This notice lists the OCPM chapters and subjects published during
the quarter covered by the notice so the reader may determine whether
any are of particular interest. The OCPM can be accessed at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
IV. OCPM Releases for July Through September 2023
The OCPM is used by OMHA adjudicators and staff to administer the
OMHA program. It offers day-to-day operating instructions, policies,
and procedures based on statutes and regulations, and OMHA directives.
The following is a list and description of OCPM provisions that
were issued or revised in the three-month period of July through
September 2023. This information is available on our website at https://www.hhs.gov/about/agencies/omha/the-appeals-process/case-processing-manual/.
OCPM Chapter 20 (Post-Adjudication Actions) Updates
OMHA issued the initial version of this chapter on May 25, 2018,
and included it in a quarterly notice published in the August 7, 2018
Federal Register (83 FR 38700). The revised chapter addresses changes
to post-adjudication appeals processing resulting from increased
electronic case processing through OMHA's Electronic Case Adjudication
and Processing Environment (ECAPE), advances in appeal filing
procedures through the e-Appeal Portal, and other improvements in
appeals operations and processing. This revision removes outdated data
entry processes that were updated with electronic case processing. This
revision also clarifies how post-adjudication actions are processed if
the original adjudicator is not available for more than 20 calendar
days; clarifies how various post-adjudication requests are filed;
updates the operational process to re-establish an appeal. Finally, the
revision adds a new section, 20.13, Requests to Obtain Approval of a
Fee, which incorporates information previously included in OCPM Chapter
5. OMHA made revisions in the following sections: 20.2.1, 20.2.2,
20.3.2, 20.3.4, 20.4.1, 20.4.3, 20.4.4, 20.4.5, 20.4.6, 20.5.2, 20.5.3,
20.5.4, 20.5.5 (multiple), 20.5.7 (multiple), 20.5.8 (multiple), 20.6.1
(multiple), 20.6.2, 20.6.4, 20.6.5 (multiple), 20.6.6.1, 20.6.7
(multiple), 20.7.1.4, 20.7.2, 20.7.4, 20.7.5 (multiple), 20.7.7
(multiple), 20.8.1.3, 20.8.2, 20.8.4, 20.8.5 (multiple), 20.8.6.1,
20.8.7 (multiple), 20.9.1, 20.9.2, 20.9.4, 20.9.5, 20.10.2, 20.10.3,
20.11.2, 20.11.4, 20.11.5, 20.11.6, 20.12.1, 20.12 (multiple), 20.13.
Karen W. Ames,
Executive Director of Operations, Office of Medicare Hearings and
Appeals.
[FR Doc. 2023-28625 Filed 12-27-23; 8:45 am]
BILLING CODE 4150-46-P
